Surgery for primary hyperparathyroidism 1962-1996: Indications and outcomes

Department of Surgery, University of Sydney, NSW.
The Medical journal of Australia (Impact Factor: 3.79). 02/1998; 168(4):153-6. DOI: 10.1016/S0022-5347(01)62032-9
Source: PubMed

ABSTRACT To examine changes over the past three decades in the indications for, and outcomes of, surgery for primary hyperparathyroidism.
Survey of a prospective hospital database.
Royal North Shore Hospital (a tertiary referral and university teaching hospital), Sydney, New South Wales, January 1962 to December 1996.
All 733 patients who underwent neck exploration for primary hyperparathyroidism.
The annual number of parathyroidectomies increased virtually exponentially, from a mean of two in 1962-1969 to 73 in 1996. In the 1960s and 1970s, the most common indication for surgery was the presence of renal calculi (58% and 43%, respectively), but in the 1980s there was a marked increase in presentation of asymptomatic disease after biochemical screening (19%). In the 1990s, low bone mineral density detected by osteodensitometry has become the most common indication for surgery (31%). After initial operation, 11 patients (2%) had persistent hypercalcaemia, with five of these cured by reoperation--an overall failure rate of 1%.
Surgery for primary hyperparathyroidism has become increasingly common, with low bone mineral density replacing renal calculi as the most common indication for surgery. Neck exploration in experienced hands results in an overall cure rate of 99%.

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    • "Primary hyperparathyroidism is among the most common endocrine disorders with a prevalence reaching 0.1% to 0.4% [1] [2]. Diagnosis of primary hyperparathyroidism is based on biochemical markers, including serum parathyroid hormone (PTH) and serum calcium [3] [4]. "
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    • "Tc-pertechnetate subtraction scintigraphy; CT, CT scan of the neck and mediastinum; TP, true positive; FN, false negative. overall cure rate greater than 90% (Arnaud 1994, Shen et al. 1997, Roe et al. 1998, Delbridge et al. 1998). However, most studies suggested that preoperative localization of abnormal parathyroid glands may be useful in reducing operative time, morbidity and hospital stay, facilitating parathyroidectomy especially in patients with ectopic parathyroid tumours (Wei & Burke 1995, Sfakianakis et al. 1996, Gupta et al. 1998, Sofferman & Nathan 1998, Vogel et al. 1998, Boggs et al. 1999, Chen et al. 1999, Lumachi et al. 1999, Song et al. 1999). "
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    • "The usual treatment is surgical removal of the parathyroid glands with follow-up drug treatment (Ball, 1996). Delbridge et al. (1998) reports a 99% cure rate for surgery though recurrences still present a significant challenge. As with phaeochromocytoma, genetic screening for HPT in MEN2A is unlikely to have significant implications for insurance on its own, due to its low penetrance, mild nature and the availablility of effective treatment. "
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